Moving to another state with a WCMSA

My name is Mike from Chicago,
Il. I have a WCMSA and self
administer the arrangement. I pay my doctor according to the Illinois Workman’s
Compensation Fee Schedule which is discounted each month from $225.00 down to
$95.27. I see this pain management doctor on a monthly basis to get my schedule
II narcotics. I will be moving to Florida
permanently as soon as my property sells in Chicago
and was wondering at what rate do I pay the doctors in Florida? Since my WCMSA specifies an
Illinois Work Comp Fee Schedule would I pay the doctors in Florida 100% of whatever their charges might
be? When I called CMS for the local Chicago region that’s
what the lady told me to do but I just want to make sure that it is the right
thing to do. Am I not entitled to any Medicare discounted price at all?

Thank you for your help,

Dear Mike:

Technically what little CMS guidance that is published would
dictate is that you would continue to pay at the fee schedule rate which was
governed by the jurisdiction in which your claim originated. In reality, the
federal government has made no provisions that require any private medical
service providers to accept WC rates absent an active WC claim, so your doctor
should be commended for cooperating. The MSA has a valid purpose, it is just
that the federal government has not done a great job of implementing a system
for it.

If CMS says you can pay full charges in Florida, I would
hope that you wrote down the name and job title of the person who told you that
and the date that you called because I would view any oral information
skeptically. Many of their employees do not fully understand the process
themselves so their opinion will not be worth much unless you can prove you received
it. Unless Barbara Wright or someone who works directly for her at the CMS MSP
Central Office in Baltimore
provided you with that information, I would remain skeptical. You may want to
pose your question in writing to mspcentral@cms.hhs.gov and get a written
response. Expect to wait 60 days or longer if they do choose to respond.

I would certainly try to negotiate the Florida WC price when
you establish a new doctor relationship in Florida. If they understand what an MSA is,
it may be no problem and may not care the claim originated in IL. What they get
is instant payment rather than waiting for Medicare or an insurance carrier to
pay and that has value to most providers. I checked a few areas around FL and
the rate for the same office visit your getting in IL is $64 in most areas. The
highest I found was $70 in Miami
so that gives you a range to shoot for. If they don’t like the rate, then you
can tell them that you are legally bound by the IL Industrial Commission to pay
only $95.27 and see what they do with that information. It’s more than they get
from FL or Medicare so that might appeal to them. If all that fails, I would do as CMS says and
just pay. When the money runs out sooner than expected, Medicare will only have
themselves to blame.

I wish could provide you will some assurances that your move
will be no problem but remember this is the federal government we are dealing
with. Do the best you can with it. That’s all they can hope for.

Enjoy your warm winter.

Jen Jordan

For questions about Medicare Set-Aside Arrangements as they
pertain to liability settlements or general questions about your obligations
under Section 111. Contact us at 888-SET-ASIDE.

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